Nutrition and Breastfeeding Articles

Eczema is a disorder of the immune system caused by an abnormal skin barrier, dryness and inflammation.
30% of people with atopic dermatitis (eczema) also have an allergy.  A food allergy may trigger eczema, but it is not the cause of the eczema. Some foods such as dairy may exacerbate eczema.
 
Eczema can be normally well managed by maintaining, protecting and treating the skin by:
-         Applying moisturiser (at least twice/day)
-        Use non-soap based wash or oil in the bath or shower
-        Avoiding soap and washes that produce bubbles or foam (as these may cause the skin to dry out)
-        Using anti-inflammatory creams and ointments, such as topical steroids
-        Treating bacterial skin infections with antibiotics
-        Use immune modulating treatments if prescribed by your doctor or dermatologist.
 
Food exclusion diets are only recommended to be tried in children with eczema when the above treatments don’t work. Food exclusion diets should be guided by a clinical immunologist or allergy specialist and dietitian. Only short term food exclusion is needed to determine if the food allergy is causing the eczema.
 
Dairy is often a common trigger for eczema, even if they are not allergic to dairy but to something else. Research has shown that more often than not food exclusion diets can be short-term. This is because eczema is an immune response, and in children, their immune system is not fully developed. It is predicted that as a child’s immune system develops, they are likely less sensitive to dairy causing eczema and can slowly introduce these foods back into their diet. It is important that this is done under close guidance of a paediatric dietitian.

References:

1. Eczema and food allergy. Fast facts. ASCIA. 2020. Available at: https://www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy

 

1. National eczema association. Everything you need to know about eczema and food allergies. 2018. Available at: https://nationaleczema.org/blog/eczema-food-allergies/

 

1. Nikolovski A, Rallis S (2020) The Impact of Dairy Elimination on Pediatric Atopic Dermatitis. J Nutri Med Diet Care 6:044. doi.org/10.23937/2572-3278.1510044

 
 

​Dairy products contain 10 essential nutrients; calcium, potassium, phosphorus, magnesium, carbohydrate, protein, vitamin A, riboflavin, vitamin B12 and zinc, important for healthy immune and blood systems, eyesight, muscle and nerve function, healthy bones, skin, energy, growth and repair of your body. If your child cannot have dairy, whether it be due to an allergy, intolerance or dislike, it is important to find alternatives that provide these nutrients.
 
Soy milk has the most similar nutritional profile to cow’s milk and is considered the best choice if your child cannot have dairy, unless they have a soy allergy. Soy milk is also high in protein. Look for soy milks with added calcium, Vitamin A, B1, B2, and B12. When opting for a milk alternative, always look for brands that contain 120mg/100mL of calcium.
 
If your child cannot have dairy and soy, other options are:
-        Oat; contains protein, fibre and is high in carbohydrates. Choose those fortified with calcium.
-        Almond milk; low in protein and carbohydrates. Again choose unsweetened brands with added calcium.
-        Coconut: High in saturated fat, and low in most nutrients e.g. protein, carbohydrates, vitamins and minerals.
-        Check out our article comparing plant vs dairy milks: https://www.nicolebando.com/articles/which-milk-a-review-of-plant-vs-dairy-milks
 
For dairy-free brands, see our article; https://www.nicolebando.com/articles/dairy-free-andor-soy-free-foods-supermarket-brands-to-look-for.
See here for information on how much dairy kids need.
 
Full cream or low fat milk?
The latest evidence suggests that full cream milk is recommended from the age of 12 months onwards, even into your adult years, unless you have high cholesterol, and then reduced fat is recommended.
 
Infants (0-12 months of age) should only be given breastmilk or infant formula. Cow’s milk as a drink is not suitable for infants under 12 months of age. Cow’s milk may be consumed as part of a meal, e.g. in cereal. 

By Emma McShane, Dietitian, November 2022 (Edited by Nicole Bando, APD, IBCLC)

By Emma McShane, Dietitian. Edited by Nicole Bando, Dietitian & IBCLC, August 2022

At a party, a small amount of sugary food is okay, though it is important to ensure the majority of the food includes healthy options for children to ensure they are being nourished for growth & their best health. Children may have many parties over a weekend, which means their opportunity to eat high sugar, processed foods is beyond their needs for growth.
 
For quick, easy packaged food options to include in your next kids’ party, check out this link:
https://www.nicolebando.com/blog/simple-packaged-snack-swaps
 
These colourful ideas also promote growth, mood, play & concentration:
 
-          Vegetable sausage rolls made with filo pastry
-          Assorted sandwiches using multigrain bread
-          Fruit skewers
-          Fruit and yoghurt cups
-          Wholemeal pita bread pizzas loaded with vegetables such as spinach, capsicum, tomato, mushrooms etc.
-          Healthy bliss balls
-          Popcorn for children over 3 years of age
-          Cheese and crackers
-          Rice crackers & dips
-          See our allergy friendly party food list 

Lolly bags have an excessive amount of sugar and minimal nutrients, and are generally not recommended. Try swapping out lollies for something else, such as colouring books and utensils, craft ideas or recipe cards for healthy foods to make at home. Or offer 1 small treat instead of a bag.

​If you are planning a party for children who have food allergies, it can seem overwhelming to know where to start. Follow these steps for safe and yummy party food. A food allergy is when a person’s immune system reacts to the protein in a food, causing symptoms such as hives, rashes or in more severe cases swelling of the mouth and throat (anaphylaxis).  Find out which allergens you need to exclude and take it from there. The key allergens are: peanuts, dairy, wheat, egg & fish.

1. Have a plan: Find out the symptoms of the child’s food allergy. Who will be supervising them? What is their allergy/anaphylaxis plan? Make sure they have their epi-pen & you or a supervising adult knows how to use it. Call an ambulance if the child demonstrates signs of an allergic reaction.
2. Know your key allergens and read the ingredients list. It is Australian law that processed foods must be clearly labelled to include allergens using their common names (e.g. egg or milk) so that they can be easily recognised. Allergens are often shown in bold in the ingredients list. There is also a ‘contains’ section that has a summary list of the allergens present in that food. Check food labels every time you buy the product, as ingredients and processes can change. 
3. What about ‘may contain traces of?’ This means that there is a potential cross-contamination risk.  It may be best to avoid these foods for safety reasons.
4. Food preparation and cross contamination: When the tiniest amount of an allergen comes into contact with another food (e.g. crumbs from wheat bread are on the bread board used to prepare gluten-free bread) it can be enough to cause an allergic reaction. Set up the food preparation area in a clean environment away from other foods being prepared. Use only clean (using hot, soapy water) equipment when preparing food. Make sure that your hands are cleaned prior to preparing and serving as well and that any products used haven’t been exposed to allergens (e.g. margarine previously used for wheat containing bread). 
5. So what party foods can I serve? Choose fresh over processed foods, it is easier to avoid multiple food allergens this way. Have fun with fruit, e.g. fruit skewers or try our simple allergy-friendly popsicle recipe: Blend 500ml of plant-based milk, 1 tb of maple syrup and your choice of 300g frozen fruit. Pour mixture into moulds, add an icy-pole stick & freeze until solid. Also try gluten-free pizza bases with vegetables (either without cheese or with vegan cheese), tofu and vegetable skewers, mini beef burgers with gluten free rolls, 100% corn chips & avocado dip, popcorn (over 3 years), rice crackers & dried fruit.  Consider party bags that are food free and perhaps involve craft, such as colouring.
6. What about the cake? Check out this allergy free birthday cake recipe! https://www.allergicprincess.com/egg-free-dairy-free-nut-free-cake/ - if looking for a wheat/gluten free option, swap out the plain flour for gluten-free flour.

 
References:

1. What is allergy? - Australasian Society of Clinical Immunology and Allergy (ASCIA) [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/patients/about-allergy/what-is-allergy
2. Avoiding Cross-Contact [Internet]. FoodAllergy.org. 2022 [cited 9 July 2022]. Available from: https://www.foodallergy.org/resources/avoiding-cross-contact
3.  [Internet]. Allergy.org.au. 2022 [cited 9 July 2022]. Available from: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_general_info_2019.pdf

 
 By Emma McShane, Dietitian, edited by Nicole Bando, Dietitian & LC, August 2022
​

When a mother is breastfeeding a baby with an allergy or intolerance to dairy and/or soy proteins, these foods may need to be eliminated from the mother’s diet for 2-4 weeks, before possible reintroduction (under guidance of a health professional). These conditions include Cow’s Milk Allergy, Food Protein Induced Allergic Proctocolitis (FPIAP) and Food Protein-Induced Enteropathy (FPIES).
 

• Both dairy and soy are common food sources of calcium, and many other important nutrients including Vitamin A, Vitamin B12, protein, zinc & magnesium.
• Calcium is vital to ensure strong bones and teeth and reduce the risk of osteoporosis, therefore it is important to find other sources of this mineral within your diet.
• A mother who cuts dairy and/or soy out of her diet may be at risk of developing weak bones and osteoporosis if she doesn’t replace these foods with alternatives
• Calcium in the breastmilk is constant and comes from the mother’s skeleton. A women’s dietary intake of calcium, or supplements does not affect the amount in breastmilk.
• The calcium taken from the mother’s bones is restored within a few months of stopping breastfeeding. Studies show that women who breastfeeds are not at higher risk of osteoporosis than a woman who does not breastfeed. 

​Below is a table of dairy-free (DF) and/or soy-free (SF) food sources of calcium. Check food labels every time you buy a food, medication or supplement, as ingredients may change. Use this guide for label reading: https://www.allergy.org.au/images/pcc/ASCIA_PCC_Dietary_avoidance_cows_milk_soy_2015.pdf

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This sample meal plan provides 1319mg of calcium across the day, and meets nutritional requirements from the five core food groups, in line with the Australian Guide to Healthy Eating (AGTHE), for a breastfeeding woman. It is a guide only. 

​Sometimes a calcium supplement is needed to ensure that you are getting the amount of calcium you need every day. Your dietitian or GP will help you decide if a supplement is necessary. 

References:
1.UCSF Health (2021). Calcium content of foods. University of California. Accessed June 10th 2021. Available from: https://www.ucsfhealth.org/education/calcium-content-of-foods
2.Nutrient Reference Values (2014). Calcium. NHMRC. Accessed June 10th 2021. Available from: https://www.nrv.gov.au/nutrients/calcium
3.Fishbein L. (2004). Multiple source of dietary calcium – some aspects of its essentiality. Regulatory Toxicology and Pharmacology. 39(2);67-80. Accessed June 10th 2021. Available from: https://doi.org/10.1016/j.yrtph.2003.11.002.
4.Gueguen L., Pointillart A. (2013). The Bioavailability of Dietary Calclium. Journal of the American College of Nutrition. 19;sup2, 119-136. Accessed June 11th 2021. Available from: 10.1080/07315724.2000.10718083
5.Australasian Society of Clinical Immunology and Allergy. Cow’s Milk (Dairy) Allergy. ASCIA, 2019. (Available from https://www.allergy.org.au/images/pcc/ff/ASCIA_Introducing_Foods_Fast_Facts_2019.pdf, accessed  May 31st, 2021).
​6. Australian Guide to Healthy Eating Serve Sizes [Internet]. Eat for Health. Australia; 2015. Accessed June 23rd 2021. Available from: https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes